As most of you know, we are pregnant again. We are expecting another boy due November 22nd. He is growing on target and has all the right pieces! He is a healthy wonderful boy. I am not sure if I am more in tune this time, but he is also very active very early and I feel him bouncing around a lot. Unlike last time, I am also looking pregnant this time, with a nice 22 week bump and I definitely had to give into maternity pants this go ‘round. It is fun to be glowing with a little more pregnancy-ness this time. I always felt like although I missed the horror stories that people tell moms last time, I also missed the community celebration as people are happy for your new life. It has been fun.
Now for the not so cheery part, as some of you know, this pregnancy has been a teeny complicated. I have been diagnosed with (most likely) a tear in my placenta. The super medical term is a placental abruption and mine is the most minor you can get, but my doctor is referring to it as a tear because we have no indication that it isn’t functioning well. So far I have had about 9 episodes where I have spotted. Although spotting can be normal, especially in the first trimester, the recurring nature is concerning. We are very fortunate that I am already in a “high risk” practice which means we have the best doctors, best nurses, and best ultrasound techs, so I am fortunate that I am not switching clinics or trying to deal with this in a normal practice.
At about 18 weeks I was diagnosed with the tear and was told that I could no longer pick up Logan. This has been really hard, aside from the obvious desire to pick him up and love on him, there is a giant practical side from the super annoying to the disappointing. I can’t lift him in and out of his crib which means someone else needs to be here at the start and end of every nap (or morning and bedtime). I can’t lift him in and out of his high chair (we actually taught him to crawl into his regular high chair for this reason and it became a toy that he won’t sit in so now we are using the booster and I am going to delay teaching him to climb in that until absolutely necessary). And of course, I can’t put him in and out of the carseat or stroller which means no walks, errands, park visits, play dates, etc. Lastly, I can’t lift him for safety situations. This is mostly not a problem at home (though kitchen tantrums are rough), but it means I can’t take him outside in the yard to play for fear he’ll run to the street, which he occasionally tries to do. It has meant a HUGE change in how Logan and I interact and a GINORMOUS change for our routine and how and when Charles works and works out. Overall we are making it work and we are SUPER thankful for my parents, who have been immensely helpful and will be here most of the summer.
I am not on bedrest (they don’t do it for abruption anymore, though they used to), but I am required to maintain a “light” activity level, which is luckily fairly consistent with my semi-remission arthritis status anyway. I am not going for longer walks, like I could, but otherwise, I am allowed to go grocery shopping, etc. I can’t lift stuff and I need to take a rest each day and also rest extra if I start spotting or cramping too badly.
So, now for the heavier stuff. As annoying as the life change stuff is (which is very annoying), the harder part is the changed outcomes for later in pregnancy. Although Logan’s pregnancy got off to a rough start and I had high disease activity, the only thing we had to come to grips with was induction at 39 weeks. Logan ended up coming on his own at 38.5 weeks and we had a great easy and safe regular labor and delivery. Logan was placed right on my chest and never had any health concerns. This delivery may be more complicated, but then again, it might not be. The doctors can’t say for sure. Overall, my risks increase across the board.
My risks of pre-term labor are much higher (bleeding stimulates the cervix to open) and so I am already being checked regularly, and that will probably even increase more to make sure my cervix isn’t opening (so far it is “a mile” long and very closed so YAY).
It also raises my risks of complications before labor, like the placenta not working as efficiently. However, so far I have no sign of any scarring or problems with the placenta, so again no worries yet and I will continue to have frequent ultrasounds to check. If the placenta doesn’t work as well, then baby would have to be born early. The things they do with ultrasound are crazy though and they can monitor blood flow throughout the chord and baby (heart, head, and abdomen) and make sure that things are working great.
It also raises my risks of a catastrophic event, like a full placental abruption. This is a life threatening event for me and the baby. Luckily we are close to hospitals, so it is unlikely to kill me but it could result in blood transfusions and intense medical situations if that happened. However, so far I have only had minor spotting and nothing has indicated that I would have a more serious event. For baby, at this point, he is not quite viable, but in the next few weeks, he will be and that will mean we will need to be even more cautious because intervention is much more time-sensitive for the baby than it is for me. This type of event is not a guarantee in someone who has a placenta tear, but the recurring nature of my tear makes my doctor nervous because my placenta doesn’t seem to be healing like it should. Some women have more major bleeds early that clear up and have no problems later. Some also have no problem and without warning have a full abruption at the end (36 weeks) in pregnancy. So again, who knows….
Lastly, it raises my risk for complications during labor. Obviously if I can’t pick up Logan, the stress of labor will be pretty intense for my placenta. This means I could have anything from minor increased bleeding to a full abruption during labor. Who knows at this point? We are going to have to spend some serious time discussing with my doctor whether a planned c-section, even a few weeks early, might improve outcomes for baby. Likely some will depend on whether things stay mild for the next while or whether they progress and get worse. We aren’t enthusiastic about the long recovery time for me since I’m such a slow healer, but we need to discuss outcomes and make the smartest decision for the baby, since a distress event could severely impact their lives.
So after explaining all of that, there is a small chance that this bleeding is something else like a cervical polyp. Almost all can be detected on ultrasound and they don’t see any, so it is unlikely, but my recurring minor bleeds could be explained by that. It isn’t enough of a chance for my doctor to change my plan (no lifting logan), or my monitoring, but it is something to give us hope for a simple rest of the pregnancy.
So, overall things are still fine, but we are being carefully monitored and going to work closely with our doctor on keeping everyone safe going forward. Please keep us in your thoughts and prayers and hopefully by thanksgiving we’ll have another healthy baby boy waking us up around the clock ;).
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